To date, proctology has not resolved the question of whether dolichosigma should be considered a malformation of acne pills or an individual variant of the norm. On the one hand, dolichosigma occurs in 15% of completely healthy children, which gives grounds to consider it a variant of the norm. On the other hand, elongation of the sigmoid colon is often accompanied by organic and functional disorders of the distal colon, which makes one think about a developmental anomaly. It is likely that dolichosigma is a kind of background for the development of clinical pathology.
Morphological examination of the intestinal walls in dolichosigma reveals structural disorders caused by intestinal stasis and chronic inflammation. sclerotic changes in the mesentery, hypertrophy of muscle fibers, myofibrosis, damage to the intramural nerve ganglia, degeneration of the mucous membrane. Thus, in the intestinal wall with dolichosigma, secondary degenerative changes take place, leading to disruption of its motor function.
Taking acne pills account the position of the intestine in the abdominal cavity and its size, the S-shaped, single-loop, double-loop and multi-loop sigmoid colon are distinguished. Dolichosigma is usually considered an elongated two-loop or multi-loop sigmoid colon, which has pathological mobility, moves freely in the abdominal cavity and retains additional loops after bowel movement. Clinical variants of dolichosigma can be variable. During the course of the disease, three forms are distinguished, which are also considered as successive stages of dolichosigma.
The decompensation stage is the most severe clinical form of dolichosigma. Constipation lasts 7 or more days, abdominal pain is a constant concern. The colon is swollen and enlarged due to the accumulation of gases and feces. Intoxication is pronounced. lack of appetite, nausea, pustular rashes on the skin. Symptoms of intestinal obstruction may occur. Only siphon enemas are effective for bowel movements. Clinical manifestations of dolichosigma are caused by morpho-functional changes in the colon, as well as chronic fecal intoxication. The timing of the development of dolichosigma symptoms depends on the degree of elongation of the sigmoid colon, changes in its tone and motility, and the compensatory capabilities of the child’s body.
Characteristic clinical signs of dolichosigma are recurrent pain in the left iliac or periumbilical region, flatulence. These phenomena intensify after a heavy meal or physical activity and disappear or decrease after bowel movement. Pain syndrome due to dolichosigmaassociated with a reflex spasm of the intestine, cicatricial changes in the sigmoid mesentery, and an inflammatory process in the intestinal wall. In most children with dolichosigma, dysfunctions of other parts of the gastrointestinal tract are detected. chronic gastroduodenitis, biliary dyskinesia, pancreatitis, dysbacteriosis, colitis, diverticular disease, etc. Frequent companions of dolichosigma in adults are hemorrhoids and varicose veins.
Due to a long absence of bowel movements, a child with dolichosigmoid may form fecal stones, develop fecal autointoxication, anemia, and irritable bowel syndrome. One of the serious complications of dolichosigma is intestinal obstruction due to nodulation, volvulus, kinks, and intussusception of the sigmoid colon. In these cases, a picture of an acute abdomen develops. Examination of a child suffering from dolichosigma reveals underweight, retarded physical development, and pale skin. Palpation of the abdominal cavity reveals intestinal loops filled with feces. A digital rectal examination reveals an empty rectum, even if the child has not had stool for a long time.
Dolichosigma in children should be differentiated from ulcerative colitis, Crohn's disease, enterobiasis, chronic appendicitis, and Hirschsprung's disease. For this purpose, the child should be consulted by a pediatric gastroenterologist, pediatric coloproctologist, and pediatric surgeon. At any stage of dolichosigma, treatment begins with complex conservative therapy. The leading role in therapeutic measures is given to the normalization of the digestive tract through diet - fractional meals, consumption of foods rich in fiber (vegetables, whole grain bread, bran, fruits, berries, herbs), fermented milk products, vegetable oils, etc. In some cases, laxatives are prescribed and microenemas, however, with dolichosigma it is extremely important to form a reflex to spontaneous defecation.
Indications for surgical treatment of dolichosigma in children are extremely rare. Surgical treatment is indicated for intestinal obstruction, failure of conservative therapy, persistent constipation, progressive fecal intoxication, the presence of unstraightened loops and kinks of the intestine. With dolichosigma, resection of the sigmoid colon is performed. In the case of predominant damage to the distal sigmoid colon, proctosigmoidectomy is the operation of choice.
Three stages of pathology development. Compensated At this stage, the patient has no pronounced complaints, thanks to the compensatory mechanism of the body. In some cases, patients complain of bowel problems in the form of recurring constipation. Incompletely compensated At this stage, constipation becomes prolonged. In this regard, flatulence and pain in the navel area are observed. Sometimes laxatives stop working. Decompensated The last stage of the disease, in which constipation lasts more than a week and intestinal obstruction often occurs, which leads to poisoning of the entire body. Causes of congenital pathology.